Individual
MR. CAREY WAYNE KETCHUM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1664 FORESTDALE BLVD, AMERICAN FAMILY CARE INC FORESTDALE CLINIC, FORESTDALE, AL 35214
(205) 791-2273
(205) 791-9753
Mailing address
2147 RIVERCHASE OFFICE RD, BIRMINGHAM, AL 35244-1836
(205) 403-8902
(205) 982-0278
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10232
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51590263
BLUE CROSS BLUE SHIELD
AL
01
—
P00155440
RAILROAD MEDICARE
AL
Enumeration date
03/02/2006
Last updated
07/08/2007
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